#I am not a virus

As I read the final chapter of Benjamin Kingsbury’s history of Quail Island, New Zealand’s leprosy colony, news of the worldwide COVID-19 pandemic began to break. Leafing back through the pages to Chapter 1, where Kingsbury describes the first suspicious case of leprosy in New Zealand in 1903, similar themes between these past and present stories of illness, suffering and infection control began to emerge. This prompted consideration of how we – as individuals, as health professionals and in our wider communities – respond to people infected with a contagious disease, and the possible consequences of our reactions for the health and wellbeing of societies across the world.

The Dark Island is a beautifully produced narrative history of the island in Lyttelton Harbour that, between 1906 and 1925, was New Zealand’s only leprosy colony. Bridget Williams Books has published another visually appealing and tactile book, printed on high-quality paper, the text interspersed with fascinating black and white photographs. The story of Quail Island is told chronologically, beginning at the time when the island became a human quarantine station in 1874. The first leprosy patient was admitted in 1906. Similarities to our present-day story immediately come to mind: fears associated with the lack of knowledge about the pathogen causing the disease, and the need to separate infectious people from the healthy.

We now know that leprosy is far less contagious than was thought in the early 1900s, but at that time the concerns regarding its spread throughout New Zealand may have felt similar to the coronavirus panic sweeping our twenty-first-century world. As I write, the Australian government is using Christmas Island – an off-shore territory near Indonesia previously used for detaining asylum seekers (a process strongly criticised by human rights groups and the United Nations) – to hold those whom they fear will bring COVID-19 to their shores. The conditions on Christmas Island are reported to be unsanitary with poor medical facilities, and are often dangerous to patients. In The Dark Island Kingsbury explains how leprosy patients were housed on the side of Quail Island receiving the least amount of sun each day, the brighter areas being reserved for agricultural stock. He documents the cold conditions, poor food, limited medical treatment, boredom and loneliness experienced by vulnerable human beings. One is left feeling that the book’s title not only reflects the number of hours of sunlight on the dismal side of Quail Island, but the wider plight of those who contracted leprosy in New Zealand at that time.

Kingsbury states in the preface that he tried to avoid using the word ‘leper’, and a respectful empathetic tone is evident in this work. His modern-day acknowledgement of patients as people, not as diseases, has sadly not always been evident in the current coronavirus outbreak, with Chinese residents in Paris needing to create the #I am not a virus campaign on Twitter. Kingsbury’s research appears to have been thorough, his writing is clear, and the chronological structure makes it an easy-to-follow, albeit somewhat unimaginative narrative. This lack of creativity in relating a true story is one reason I don’t often read history books for pleasure. I found myself wanting Kingsbury to draw out and discuss themes that suggested themselves throughout his book. For example, the stories of health professionals – including Dr Charles Upham, the colony’s doctor for most of its nineteen years, and Dr Arnold Knowles, who accompanied a group of leprosy sufferers on a boat journey across the Pacific Ocean – are told in minimal detail and in separate chapters. Kingsbury implies that Upham was a diligent and caring local GP, but writes that Knowles made a poor impression, being ‘rough and objectionable in his behaviour to the patients’, having secured a pay rise and an allowance of ‘medical comforts’ (three bottles of brandy, twelve bottles of Penfolds wine and 1500 cigarettes!) before agreeing to make the journey.

The tales of these two medical men – and other personnel on Quail Island and within the Health Department – are as varied as doctors are today: some of us are caring and diligent; some of us struggle to cope with the demands of a medical career and go off the rails; some of us demonstrate a mixture of behaviours. Kingsbury may have been wise not to divert into such discussions, but how society responds to the outbreak of infectious disease may in part be determined by how medical professionals respond. In the current pandemic, the World Health Organisation is working hard to communicate a factual, evidence-based and pragmatic approach, although their advice has not been adopted by all countries. At the start of the twentieth century there were very different methods of communication, but myths and rumours were as abundant then as they are now. Kingsbury informs us that patients who died of leprosy were buried in separate cemeteries as people feared contagion after death. He also indicates that Māori communities responded to people suffering from leprosy in a more inclusive manner than did Pākehā, provoking thoughts about how different cultures respond to those who are infirm.

Another theme – perhaps the most important one to emerge from this book – is how governments and communities respond to outbreaks of infectious disease. In the early 1900s the hostile response of the Christchurch community (and later, broader New Zealand society) to these patients, some of whom were Chinese immigrants, others indigenous Māori, could have been explained by poor understanding of a disfiguring disease for which few treatment options were available. But other prejudices may have been at play. Kingsbury’s narrative of the placement of victims in a cold camp away from human warmth, in a place where animals were given higher priority than people, runs like an icy river through his book and leaves a lasting impression.

In later chapters we learn how Canterbury health authorities tried to transfer the Quail Island patients to Auckland. They were not welcome there, and were eventually shipped far away across the Pacific Ocean – with a drunken doctor in charge – to the Fijian island of Makogai. The authorities’ arguments that the Fijian medical centre could offer better treatment, a better climate etcetera, were not particularly convincing to me. I suspect Benjamin Kingsbury felt the same discomfort about a government removing people with the smell of death about them from sight, making them someone else’s problem. For this reason alone, read The Dark Island. Let it provoke you to question whether there has been any progress, in the last hundred years, in our treatment of those with infectious diseases.

MIRA HARRISON is a doctor, writer and human rights activist. Admissions (Steele Roberts, 2018), her first collection of linked stories about women working in a public hospital in Southern Aotearoa, is available worldwide via Amazon KDP (www.amazon.co.uk/dp/B087T71964). Mira is the author and editor of Medicines for Women and An Introduction to Pharmacovigilance and has just finished a novel called One In Three, about a junior doctor’s first year in the British NHS. (www.miraharrison.com)